[Chronic inflammation, oxidative stress and effects of erythropoetin in end-stage renal disease patients].
BACKGROUND
A few small-scale studies have shown that high levels of various parameters of inflammation were associated with a less efficient response to erythropoetin. The responsiveness to EPO in haemodialysis (HD) patients with relative risk of cardiovascular disease (CVD) remains undetermined. In a retrospective study of HD patients, we compared causes of CV morbidity and mortality in relation to various weekly EPO doses needed for stable hemoglobin (Hb) levels, according to the definition currently suggested by international guidelines.


METHODS
On the basis of distribution of the weekly EPO doses (lower or higher than the minimally recommended), eighteen HD patients, aged 55.8+/-14.8 years, were divided into two groups with higher (A) and lower (B) EPO doses. We correlated EPO doses with positive (C reactive protein-CRP, fibrinogen, feritin) and negative (albumin, LDL, TIBC) acute phase reactans, BMI, the quality (Kt/V) and duration of HD.


RESULTS
We also found a significantly positive corelation between CRP levels on the start of EPO therapy and weekly EPO dose in the univariate linear regression analysis (p-0.290). Higher EPO doses were associated with a lower levels of Kt/V, BMI, residual diuresis and higher levels of CRP, LDL, feritin, age and duration of HD. CRP levels were decreasing in the group with higher EPO doses. This important result can be explained the know EPO effect of endothelial cells apoptosis and inhibiting inflammation induced by HD.


CONCLUSIONS
Chronic inflammation is a common cause of CVD, hyporesponsiveness to EPO and endothelial dysfuncton in HD patients. Our results suggest a new protective function of EPO.
Lazarević
Tatjana
T
Klinika za urologiju i nefrologiju, Klinicki centar Kragujevac, Kragujevac. tlazarevickg@sbb.yu
Stojimirović
Biljana
B
Poskurica
Mileta
M
Lazarević
Marina
M
Mitrović
Natasa
N
Stolić
Radojica
R
D000740:Anemia / Q000097:blood / Q000188:drug therapy / Q000209:etiology; D002097:C-Reactive Protein / Q000032:analysis; D004921:Erythropoietin / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007249:Inflammation; D018836:Inflammation Mediators / Q000097:blood; D007676:Kidney Failure, Chronic / Q000150:complications / Q000378:metabolism* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D018384:Oxidative Stress; D011994:Recombinant Proteins; D006435:Renal Dialysis / Q000009:adverse effects
D018836:Inflammation Mediators; D011994:Recombinant Proteins; D004921:Erythropoietin; D002097:C-Reactive Protein